The inexorable increase in health care costs, seemingly impervious to most market-based attempts at amelioration, has led to a growing interest in measuring efficiency of health care as a key component of quality of care.1 Although there have been creative attempts by the insurance industry to develop meaningful efficiency measures, physicians are suspicious that payers are concerned only about the cost component and not about the quality component when measuring efficiency.2 But, in addition to questions about the method and accuracy of measurements of efficiency, an underlying set of concerns have been expressed by the physician sector of the health care provider community regarding their role in managing health care resources, concerns that stem from the deep and profound roots of medical ethics.